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স্বাগতম<br />
MIPO (Minimal Invasive Plate Osteosynthesis)A Good Option for  Treatment of Comminuted Diaphyseal and Metaphyseal  Fractur...
Presented by<br />Dr. Mohammad KhurshedAlam<br />Assistant Professor<br />Department of Orthopaedics and Traumatology<br /...
Our study<br />Place of Study: <br />Dhaka Medical College Hospital and private clinics in Dhaka.<br />Period of study: Ju...
Mipo<br />MIPO: minimally invasive plate osteosynthesis<br />Tunneling a plate across a fracture via small skin incisions ...
Mipo-Benefits<br />MIPO<br />
Indication<br />MIPO is most suitable for<br />Multi-fragmentary fractures<br />Fractures extending to the articular surfa...
Contraindications<br />Severe soft tissue loss with no coverage of exposed bone<br />Associated vascular injuries<br />Com...
Fractures we faced.<br />3<br />4<br />
Fractures we faced.<br />
Fractures we faced.<br />
Options we have<br />
Choice of implants.<br />Locking plates and screws<br />
Surgical Procedure<br />Positioning of the patient<br />Manual Reduction<br />
Surgical Procedure…<br />Primary fixation on the condyles<br />Incision and insertion of the plate.<br />
Surgical Procedure…<br />K-wire fixation with the shaft<br />Second incision and palpation of the plate<br />
Surgical Procedure…<br />Distal screw insertion<br />First proximal screw insertion<br />
Surgical Procedure…<br />Fixation of plate  with the shaft<br />Completed osteosynthesis<br />
After care<br />Isometric quardiceps exercise from 1st POD.<br />Non-weight bearing crutch walking when pain subsides<br /...
Our experiences<br />Case one details:<br />Mrs. Patient, 45 years old house –wife.<br />H/O Fall on the ground.<br />Fixa...
Our experiences…<br />After Reduction<br />Position of the plate<br />
Our experiences…<br />Fixation checked under C-Arm<br />Skin incision closure<br />
Follow-up after 6 wks<br />Follow-up after 12 wks<br />Our experiences…<br />
Our experiences…<br />Case two details:<br />Mr. Patient, 42 years old Banker. <br />H/O Motor bike accident.<br />Fixatio...
Follow up after 2 wks<br />After 4 wks.<br />Our experiences…<br />
Our experiences…<br />Follow-up after 6 wks of fixation.<br />Follow-up after 6 wks of fixation<br />
Our experiences…<br />After 12 wks <br />
Another case:<br />Our experiences…<br />Mr. Patient2, 25 years, male<br />H/O Road traffic accident<br />A case of Polytr...
Communited # Distal radius with articular extension
Posterior dislocation of hip.</li></li></ul><li>Per-operative X-ray<br />Follow-up after 6 wks<br />Our experiences…<br />
Outcome<br />23 patients were studied, 3 lost in follow-up<br />Average age 31.5 years (20-50 years). <br />
Outcome<br /><ul><li> Out of 20 fractures , 15 diaphyseal and 5 Metaphyseal.
15 from RTA and 5 from fall from height.</li></li></ul><li>Outcome<br />Time of surgery:<br />7- 15 days (Average 9 days)....
Outcome<br />Fracture union time:<br /><ul><li>18 fractures were united within 16-28 weeks (average- 18 weeks) ,
2 had delayed union :>32 weeks . </li></ul>Alignment after union:<br />There were no varus  or valgus  mal-alignment more ...
10 degrees ⁰ varus angulation: One patient</li></li></ul><li>Outcome<br />Criteria:<br />Fracture union <br />Knee ROM  <b...
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Mipo

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Minimally invasive plate osteosynthesis is a new technics in Bangladesh. This presentation is for Annual BOSCON Conference, 2011

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Mipo

  1. 1. স্বাগতম<br />
  2. 2. MIPO (Minimal Invasive Plate Osteosynthesis)A Good Option for Treatment of Comminuted Diaphyseal and Metaphyseal Fracture of a Weight bearing Long bone.<br />
  3. 3. Presented by<br />Dr. Mohammad KhurshedAlam<br />Assistant Professor<br />Department of Orthopaedics and Traumatology<br />Dhaka Medical College<br />
  4. 4. Our study<br />Place of Study: <br />Dhaka Medical College Hospital and private clinics in Dhaka.<br />Period of study: July 2009---December 2010<br />Study Population:<br /> comminuted diaphyseal and metaphyseal fracture of Femur and tibia.<br />Number of Patients: 23<br />Follow-up Period: 6 months to 18 months<br />Fixation Techniques: MIPO<br />Implant used: LCP/ Metaphyseal Locking Plate <br /> (Distal Femoral / Proximal Tibial )<br />
  5. 5. Mipo<br />MIPO: minimally invasive plate osteosynthesis<br />Tunneling a plate across a fracture via small skin incisions at each end of the bone. <br />avoids the long surgery time and big wounds associated with traditional plate fixation<br />
  6. 6. Mipo-Benefits<br />MIPO<br />
  7. 7. Indication<br />MIPO is most suitable for<br />Multi-fragmentary fractures<br />Fractures extending to the articular surfaces<br />Segmental Fractures<br />Narrow medullary canals (<9mm)<br />Deformed shaft ( malunion)<br />Open fractures, after wound coverage & <br /> infection control.<br />
  8. 8. Contraindications<br />Severe soft tissue loss with no coverage of exposed bone<br />Associated vascular injuries<br />Compartment Syndrome<br />Pathological fractures<br />Osteomyelitis<br />Delayed surgery with shortening of the limb<br />Delayed reconstruction ( required bone graft)<br />
  9. 9. Fractures we faced.<br />3<br />4<br />
  10. 10. Fractures we faced.<br />
  11. 11. Fractures we faced.<br />
  12. 12. Options we have<br />
  13. 13. Choice of implants.<br />Locking plates and screws<br />
  14. 14. Surgical Procedure<br />Positioning of the patient<br />Manual Reduction<br />
  15. 15. Surgical Procedure…<br />Primary fixation on the condyles<br />Incision and insertion of the plate.<br />
  16. 16. Surgical Procedure…<br />K-wire fixation with the shaft<br />Second incision and palpation of the plate<br />
  17. 17. Surgical Procedure…<br />Distal screw insertion<br />First proximal screw insertion<br />
  18. 18. Surgical Procedure…<br />Fixation of plate with the shaft<br />Completed osteosynthesis<br />
  19. 19. After care<br />Isometric quardiceps exercise from 1st POD.<br />Non-weight bearing crutch walking when pain subsides<br />knee bending exercise after 4 weeks. <br />Toe touch weight bearing after 6 weeks. <br />partial weight bearing from 12 weeks <br />full weight bearing from 20 -22 weeks after seeing the progress in X –ray . <br /> Radiographic evaluation was performed every six weeks until complete healing occurs.<br />
  20. 20. Our experiences<br />Case one details:<br />Mrs. Patient, 45 years old house –wife.<br />H/O Fall on the ground.<br />Fixation done after 7 days of trauma<br />
  21. 21. Our experiences…<br />After Reduction<br />Position of the plate<br />
  22. 22. Our experiences…<br />Fixation checked under C-Arm<br />Skin incision closure<br />
  23. 23. Follow-up after 6 wks<br />Follow-up after 12 wks<br />Our experiences…<br />
  24. 24. Our experiences…<br />Case two details:<br />Mr. Patient, 42 years old Banker. <br />H/O Motor bike accident.<br />Fixation done after 10 days of trauma.<br />
  25. 25. Follow up after 2 wks<br />After 4 wks.<br />Our experiences…<br />
  26. 26. Our experiences…<br />Follow-up after 6 wks of fixation.<br />Follow-up after 6 wks of fixation<br />
  27. 27. Our experiences…<br />After 12 wks <br />
  28. 28. Another case:<br />Our experiences…<br />Mr. Patient2, 25 years, male<br />H/O Road traffic accident<br />A case of Polytrauma<br />Head injury with <br /><ul><li>Communited # shaft tibia
  29. 29. Communited # Distal radius with articular extension
  30. 30. Posterior dislocation of hip.</li></li></ul><li>Per-operative X-ray<br />Follow-up after 6 wks<br />Our experiences…<br />
  31. 31. Outcome<br />23 patients were studied, 3 lost in follow-up<br />Average age 31.5 years (20-50 years). <br />
  32. 32. Outcome<br /><ul><li> Out of 20 fractures , 15 diaphyseal and 5 Metaphyseal.
  33. 33. 15 from RTA and 5 from fall from height.</li></li></ul><li>Outcome<br />Time of surgery:<br />7- 15 days (Average 9 days). <br />operating time:<br />Average 105 minutes (90minutes-135 minutes). <br />Average C-arm /X-ray exposure : <br />7 minutes (5 – 12 minutes). <br />Follow up period: <br />6 months to 18 months (average 12 months). <br />
  34. 34. Outcome<br />Fracture union time:<br /><ul><li>18 fractures were united within 16-28 weeks (average- 18 weeks) ,
  35. 35. 2 had delayed union :>32 weeks . </li></ul>Alignment after union:<br />There were no varus or valgus mal-alignment more than 10⁰<br /><ul><li>10 ⁰(A/P) mal-alignment: One patient
  36. 36. 10 degrees ⁰ varus angulation: One patient</li></li></ul><li>Outcome<br />Criteria:<br />Fracture union <br />Knee ROM <br />Ability to return to previous activities<br /> One patient required one dose of bone marrow injection for fracture union .<br /> one has to change his profession.<br />
  37. 37. Conclusion<br /> “MIPO technique is the good option for comminuted, diaphyseal and metaphyseal fracture <br /> of a weight bearing long bone”<br />
  38. 38. ধন্যবাদসবাইকে<br />

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